Category Archives: Grafts/Fistulas
Report on the Hemodialysis Reliable Outflow (HeRO) experience in dialysis patients with central venous occlusions.
Hemodialysis.com eInterview with Justin Wallace MD
General Surgery and Vascular Labs
T32 Trainee 4th Year Resident
University of Pittsburgh Medical Center, Pittsburgh, Pa
Written Interview conducted with author by Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Dr. Wallace: Our experience with the HeRO graft thus far does not reflect the overwhelmingly positive reports (although few) previously published. Successful placement rates were high and infection rates were low, but 22% of successful placements resulted in steal syndrome that required removal in the immediate postoperative period. Interestingly, all four incidences of steal syndrome occurred in females and each met the HeRO IFU placement requirements. Additionally, the observed 12-month primary and secondary patency rates of 11% and 37%, respectively, are significantly lower than the rates of prior reports and should temper provider and patient expectations.
Marie Benz, MD on Google+Type of arteriovenous vascular access and association with patency and mortality.
Hemodialysis.com eInterview with Gürbey Ocak,
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
Written Interview conducted with author by Editor Marie Benz, MD
Hemodialysis.com: What are the main findings of the study?
Answer: We prospectively followed 919 incident hemodialysis patients in our study. We investigated risk factors for primary patency loss in patients with a graft or fistula. Furthermore, we investigated the association between graft versus fistula use and two-year primary patency loss and two-year mortality. Cardiovascular disease, prior catheter use, albumin, hsCRP, and fetuin-A are risk factors for patency loss. Graft use as compared with fistula use was associated with an increased risk of patency loss and mortality.
Chronic kidney disease and dialysis access in women
Hemodialysis.com eInterview with Dr. Victoria J. Teodorescu
Associate Professor of Surgery
Mt. Sinai Hospital, New York
Hemodialyisis.com: What are the main findings of your review?
Dr. Teodorescu: This review article highlights some of the differences between men and women in progression to renal failure as well as creation of dialysis access. The diagnosis of chronic kidney disease (CKD) is based on low kidney function which may be estimated taking serum creatinine, age, race and sex. Sex is important because men have a higher level of kidney function at the same level of serum creatinine. This is important to recognize as clinicians who refer patients for dialysis access at a fixed level of creatinine, 4 mg/dL for example, would be systematically referring women at a more advanced stage.
Increased Blood Loss From Access Cannulation Site During Hemodialysis Is Associated With Anemia and Arteriovenous Graft Use
Hemodialysis.com eInterview with Dr Yen-Ling Chiu
Department of Nephrology
No.21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City 220, Taiwan
Hemodialysis.com: What are the main findings of the study?
A: We found that a significant percentage of patients will experience excessive blood loss from the fistula/graft cannulation sites during treatment. Such excessive bleeding is more common among graft users, the elderly and is associated with anemia. These patients are in general less healthy.
The PICC Epidemic and the Kidney Patient
Hemodialysis.com eInterview: Rita McGill MD
Allegheny General Hospital
Pittsburgh, PA USA
The major finding of this study is that more than 20% of hospital inpatients have PICC lines. Compared to hospital patients in general, PICC patients are sicker and have more chronic kidney disease. This is particularly unfortunate, since national ASDIN guidelines advise against PICC placement in kidney patients. Despite this recommendation, CKD patients actually bear a disproportionate brunt of the PICC ‘epidemic, with a PICC rate of 30%, which is higher than other patients.
Candidate Gene Analysis of Arteriovenous Fistula Failure in Hemodialysis Patients
Hemodialysis.com Author Interview: Dr. Joris I. Rotmans, MD PhD
Department of Nephrology, Leiden University Medical Center,
PO Box 9600, 2300 RC Leiden, The Netherlands
The Einthoven Laboratory
Experimental Vascular Medicine is the workshop of the theme Vascular Medicine
Leiden University Medical Center (LUMC).
Hemodialysis.com: What was the rationale for the study?
Dr. Rotmans: Vascular access dysfunction is currently the Achilles’ heel of hemodialysis therapy. The vast majority of arteriovenous access failure is caused by thrombosis, secondary to disproportionate intimal hyperplasia and impaired outward remodeling of the venous outflow tract. Currently, it is unknown why AVF failure occurs in some individuals but not in others. We investigated whether genetic risk factors might play a role in AVF failure.
Experience of HeRO Dialysis Graft Placement in a Challenging Population
Hemodialysis.com Interview with: Harry Schanzer, M.D., F.A.C.S.
Clinical Professor of Surgery
Division of Vascular Surgery
Mount Sinai School of Medicine
Hemodialysis.com: What are the main findings of the study?
Dr. Schanzer: Eleven patients with central venous occlusive disease underwent 12 HeRO placements as a last ditch effort for long-term hemodialysis access. At one year, primary and secondary patencies were 9.1% and 45.5%. Four HeRO grafts were never cannulated, and the remaining 11 had a functional patency of an average of 14 months
Associations between Hemodialysis Access Type and Clinical Outcomes: A Systematic Review
Hemodialysis.com Author Interview: Dr. Pietro Ravani,
University of Calgary, Faculty of Medicine,
Foothills Medical Centre, 1403 29th Street NW, Calgary
Alberta, Canada T2N 2T9
Hemodialysis.com: What are the main findings of the study?
Dr. Ravani: Most available data compare outcomes by access achieved/used rather than access intended/planned.
